Insurance reforms only part of reducing medical costs

May 13, 2011 9:21 pm

There has been much consternation in Augusta in recent days about a Republican proposal to rewrite the state’s health insurance regulations. The proposed changes aim to reduce the cost of buying insurance by changing the rules insurance companies must follow. While this is important, but complex and contentious work, it is only part of the solution to reducing insurance costs. Without looking at the costs of medical care, any insurance reform will be only partially successful.

A 2000 paper by the Maine Bureau of Insurance, circulated by Republicans to bolster their case for easing state health insurance mandates, lists many reasons for Maine’s high insurance rates. Rising health care costs is the first item listed.

Getting accurate data, including about the actual costs of care provided by hospitals and doctors’ offices, is difficult and time-consuming. The Maine Health Management Coalition has been quietly working in this area for years. One result of its work is a publicly accessible database that rates Maine health care providers based on quality.

“It may not be immediately obvious why organizations like Jackson Laboratories, Bath Iron Works, Maine General Health, the State Employee Health Commission and Franklin Community Health — among many others — would put such a high priority on improved access to health data. The simple explanation is that we cannot improve our health care system without it,” Elizabeth Mitchell, the coalition’s CEO, told the Health and Human Services Committee last week. “It is the foundation of improved, more coordinated, more appropriate, and safer patient care. It is also the key to reducing health care costs through improved care delivery.”

The coalition strongly supports LD 1467, which aims to make the data needed to improve health care quality more accessible.

The data that are currently available are not helpful to providers trying to improve patient care because they are too limited and not timely. Under the Affordable Care Act, the federal health reform legislation, medical providers will need to be able to track the health of their patients. This is meant to shift the focus away from providing more treatment, because this is what doctors and hospitals are paid for, and instead to provide incentives for preventive care, which reduces costs in the long run. LD 1467 moves in that direction, but only if the work it requires is done in a timely and effective way.

Getting a clearer picture of what health care costs and what treatments are most effective is critical to lowering medical and insurance costs.